集束化护理干预策略对重型颅脑损伤患者呼吸机相关性肺炎的影响

目的探讨集束化护理干预策略在重型颅脑损伤患者预防呼吸机相关性肺炎中的实施效果。方法选取2012年1—12月蚌埠医学院第一附属医院ICU收住的重型颅脑损伤机械通气患者30例作为集束化护理干预组，另选取2011年1—12月蚌埠医学院第一附属医院ICU收住的重型颅脑损伤机械通气患者30例作为对照组。比较2组呼吸机相关性肺炎（VAP）发生率，机械通气时间和ICU住院天数。对照组实施常规护理：半卧位；口腔护理每日2次；每日唤醒和每天评估拔管脱机的可能；预防应激性溃疡。集束化护理干预组在常规护理的基础上增加了持续声门下吸引；预防深静脉血栓和增加口腔护理的频次为每日6次；重视？肖毒隔离。结果集束化护理干预组VAP发生率比对照组低，机械通气时间和ICU住院时间也较对照组缩短，2组差异有统计学意义（P〈0．05）。结论集束化护理干预措施能有效降低重型颅脑损伤患者呼吸机相关性肺炎发生率，缩短患者机械通气时间和ICU住院时间。

Impact of care bundle on occurring of ventilator-associated pneumonia in patients with severe head injury

Objective To investigate the efficacy of care bundle on prevention of the ventilator-associated pneumonia （VAP） in patients with severe brain injury. Methods Total 30 patients with severe brain injury admitted to ICU from January 2012 to December 2012 treated with mechanical ventilation were recruited in the observation group ,other 30 patients from January 2011 to December 2011 in the control group. The control group received the routine care including semi-recumbent position, oral care 2 times a day, daily wake-up and daily assessment of the possibility of extubation, preventing of stress ulcers. The observation group received preventing of deep vein thrombosis and increasing the frequency of oral care （6 times a day）, careful disinfection and isolation, based on the routine nursing care. The incidence of VAP, duration of mechanical ventilation,and days in ICU were compared between the two groups. Results As compared to the control group,the incidence of VAP was lower, and the duration of mechanical ventilation and staying days in ICU were shorter in the observation group（ P 〈 0.05 ）. Conclusion The care bundle can decrease the incidence of VAP, shorten the duration of mechanical ventilation and ICU stay days in severe head injury patients with mechanical ventilation.